Malignant and benign cancers Flashcards
What is the most common primary tumour in the head and neck?
Squamous cell carcinoma
What is the clinical presentation of oral cancer?
O ral ulceration R ed or whit patches A bnormal swellings L oss of tongue mobility C auliflower like growths A bnormal localised tooth mobility N on healing tooth sockets C olour changes in mucosa (brown/blue) E rosions in mucosa R educed or altered sensation
What type of biopsy for a suspected oral cancer?
Incisional biopsy
How do you carry out a fine needle aspiration cytology?
Green needle with syringe leaving 1ml of air in syringe
Needle in lump - negative pressure suction to get cellular content into needs
Take needle off, put air in syringe, needle back on, squirt aspirate on slide
What are the objectives of cancer surgery?
- Excise entire neoplastic lesion
- Promote rapid healing and rapid restoration of function
- Remove margin of adjacent normal tissue in anticipation of microscopic spread
- Remove potential channel of metastasis e.g. lymphatics, nerves (usually neck dissections)
In oral cancer classification, what are the tumours classified as?
T1 <2cm
T2 <4cm
T3 >4cm
T4 - infiltrating deep structures
In oral cancer classification, what are the nodes classified as?
N1 - mobile nodes <3cm, ipsilateral
N2 - mobile nodes 3-6cm, contra or bilateral
N3 - fixed nodes >6cm
In oral cancer classification, what is metastasis classified as?
M1 - distant metastasis present
What is the oral cancer staging for:
a) Stage I
b) Stage II
c) Stage III
d) Stage IV
a) T1 N0 M0
b) T2 N0 M0
c) T3 N0 M0 or T1/T2/T3 N1 M0
d) T4 or any T with N2/3 M0 or any T with any N and M1
What are the benefits of laser excision of SCC?
Heals with less scarring
Heals by secondary intention - granulates from base and re-epithelialize
Coagulates as you remove tissue so less bleeding
Can be more accurate
What is the procedure for a free flap surgery?
1) Pedicule flap: bilateral naso-labial flap
2) Blood supply from naso-labial artery so knife not put through lower part - leave attached at base
3) Hole through cheek going into mouth so can fold tissue and stitch into place
4) Few months later starts to epithelialise
5) Sectioning of pedicule when its aquired its own blood supply
If the cancer is large, what type of surgery may be required?
Free tissue transfer
Where is the most common place to get tissue from when free tissue transfer surgery is done?
Radial-forearm free flap (blood supply from radial artery)
When is radiotherapy indicated?
1) Indicated where pt unfit for surgery
2) Where surgery may produce significant deformity or functional morbidity
3) Out-pt procedure usually
4) Immediate and delayed morbidity e.g. osteoradionecrosis
What are the types of spread of malignancies?
Direct spread - local
Lymphatic spread - to lymph nodes
Haematogenous spread - usually distant
Transcoelomic spread - peritoneal cavity/pleural space
What are the risk factors for developing breast cancer?
Age :increases with age Individual or FH of breast cancer History of ovarian cancer Oestrogen exposure Atypical hyperplasia of the breast Lifestyle - obesity, alcohol, smoking Radiation to area Genetic predisposition Lobular carcinoma in situ (LCIS)
What mutation genetically predisposes a person to breast cancer?
Mutation to BRCA 1 or BRCA2 genes cause 2-3% all breast cancers - autosomal dominant
What are the types of breast cancer?
a) DCIS
b) LCIS
c) IDC
d) ILC
a) Ductal carcinoma in situ
b) Lobular carcinoma in situ
c) Invasive ductal carcinoma
d) Invasive lobular carcinoma
What is a key sign often seen in inflammatory breast cancer?
Peau d’orange (orange peel skin)
What are some benign causes of breast lumps?
Breast cysts
Fibroadenomas
Abscess
What are the symptoms of breast cancer?
New lumps or thickening in breast or underarn
Nipple tenderness, discharge or physical changes
Skin irritation or changes e.g. puckers, dimples, scaliness
Warm, red, swollen breasts, rash orange skin
Pain in breast
What are the treatment options for breast cancer?
Surgery - wide local excision, full mastectomy
Radiation therapy
Chemotherapy
Hormone therapy
What are the risk factors for developing lung cancer?
- Number of cigarettes smoked
- Age at which person started smoking
- How long a person has smoked (or smoked before quitting)
- Passive smoking
- Pollution, asbestos, occupational exposures
Persistent smokers die 10 years younger than non-smokers and 85% lung cancers occur in a smoker
What are the types of lung cancers?
Adenocarcinoma (30-40%) SCC (30%) Large cell (10%) Small cell (20%) Carcinoid lung cancer (1%) Mesothelioma (asbestos related)
What are the signs and symptoms of lung cancer?
Shortness of breath
New cough or cough that does not go away
Chest pain in 1/4 - dull aching and persistent
Coughing up blood (haemoptysis)
Repeated respiratory infections e.g. bronchitis or pneumonia
Wheezing or hoarseness
What does a PET scan show?
Metastases to bone
What is the prognosis of lung cancer?
5-7% 5 year survival
What is the most common type of prostate cancer? What are the other types?
Adenocarcinoma
Transitional cell, SCC, small cell
What are the risk factors for prostate cancer?
Age - most common 75-79 years Ethnicity - more common in black african men Family history Obesity Male
What are the signs and symptoms of prostate cancer?
Cause bladder outflow and irritability symptoms (just like benign prostatic hypertrophy: nocturnia, urgency, poor stream/dribbling, frequency of micturition
Haematuria (blood in urine)
Metastases to bone - commonly lower back pain
Why can prostate cancer easily spread to the vertebrae?
Venous plexus around vertebrae with the prostate directly related - no valves so spreads easily through bloodstream
What is prostate cancer staged with?
Gleason score : pathology based from a sample
What is the treatment of prostate cancer?
Early disease: Surgery, radiation and brachytherapy (localised radiation), cryotherapy, watchful waiting
Advanced disease: Hormone therapy, chemotherapy, pain management
What are the different types of kidney cancer?
Clear cell (75%) Papillary (15%) Chromophobe (5%) Transitional cell carcinoma Wilm's tumour - malignant nephroblastoma occurring in children
What are the risk factors for kidney cancer?
Male Obesity Hypertension Increasing age - most commonly 60-70 Smoking Dialysis (increased risk of developing cysts which increases risk of cancer) Family history Thyroid cancer Genetics - von hipple-lindau syndrome, tuberous sclerosis
What are the signs and symptoms of kidney cancer?
Pain - loin radiating to groin
Haematuria - blood in urine
Metastases - lung bone
What is the treatment for kidney cancer?
Watchful waiting
Surgery - nephrectomy, can be curative, used in up to stage 3
Cryotherapy - freeze cancer
Radiofrequency ablation
Immunotherapy
Chemotherapy (less commonly used)
Radiotherapy (less commonly used as less sensitive)
Why are bisphosphonates used for breast, lung, prostate, kidney cancers?
- Treatment of bone pain
- Breast cancer reduces risk of cancer spreading to bone
- Prevention of osteoporosis in pts taking hormone therapy
- Tx of hypercalcaemia
Why is radiotherapy used as a neoadjuvant or induction treatment?
Given before surgery to shrink the tumour
Why is radiotherapy used as an adjuvant treatment?
Given after surgery to destroy any residual tumour cells if worried its not fully cleared or margins very close to normal tissues
When would total body irradiation be indicated?
For bone marrow transplants
What do the Royal College of Radiologists estimate most cancers are cured by to the least?
49% by surgery
40% by radiation
11% by chemotherapy
However usually used in combination
In what part of the cell cycle does radiation do the greatest damage?
Mitosis
What is the basis of how radiation therapy works?
X-rays have high enough energy to displace electron from its path (ionisation) creating an unstable atom. The DNA is targeted, double strand breaks with a poor chancer of repair, leading to cell death and tumour necrosis
What does the unit of measurement Gray (Gy) mean in radiation?
Radiation-absorbed dose
Depositis 1 J/kg tissue of energy
What does the unit of measurement Sievert (Sv) mean in radiation?
Dose equivalent - equal to gray times a quality factor - takes into consideration the biological effectiveness of radiation
Deposits 1 J/Kg tissue of energy
What is somatic certainty in radiation? What is somatic non-deterministic effect?
A threshold for when effect will occur
Change it may occur e.g. malignancy
At what dose in Sv would a) radiation sickness and b) death occur (somatic certainity)?
a) 2-10 Sv (bitewing is 0.0002mSv)
b) >10 Sv
At what dose in Gy would the following occur?
a) death in a few hours from CNS damage
b) Death in 3-7 days from destruction of GIT mucosal lining causing diarrhoea and septicaemic shock?
c) Death in 2-3 weeks from bone marrow destruction
d) Damage to foetus in early pregnancy
a) >50 Gy
b) 5-10 Gy
c) 2-5 Gy
d) 0.2-1 Gy
What does is required to treat a tumour in Gy? How is this given to the patient?
Around 50Gy
Given in fractions over 4-6 weeks to allow normal tissues to recover
In radiation therapy, how is external radiation/ collateral damage to adjacent tissues minimised?
- Compress tissues with mask
- Collimation to focus beam of radiation
- Multi-field technique. coming at different angles so high dose to tumour and lower dose to surrounding tissues
In internal radiation therapy, what are the following used for?
a) 131 I
b) 32 P
c) 125 I
a) Carcinoma of thyroid - injected via arm or groin
b) Bone marrow radiation
c) Brachytherapy
What is internal radiation therapy and what are its advantages?
Brings the radiation as close as possible to the tumour e.g. brachytherapy seeds
- Specific radiation to tumour tissue
- Less collateral damage
- Higher doses possible
What are the general side effects of radiotherapy?
Tiredness
Nausea
Loss of hair at site of beam entry
Loss of appetite (weight loss)
Soreness of skin and erythema at site of beam enry
Risk of radiation induced malignancy (after several years)
Skin pigmentation
What are the oral side effects of radiotherapy?
Mucositis (inflamed mucosa)
Xerostomia
Ulceration
Candidiasis - clears out oral flora so more susceptiple
Radiation caries - on surfaces you dont expect, give fluoride supplements
Dental hypersensitivity
Periodontal disease
Loss of taste
Trismus - due to increased fibrous muscles, asymmetric mouth opening
Craniofacial defects if given during growth
Osteoradionecrosis
What is osteoradionecrosis? How is it avoided?
Complication due to irradiation endarteritis obliterans resulting in progressive poor blood supply and a diminishing ability to heal. Problem often occurs following dental extractions
Remove poor prognosis teeth before treatment and if XTNs necessary after DXT to jaws then specialist, antibiotics and hyperbaric oxygen
Where are metastases in jaws or oral soft tissues usually from?
Breast, lung, prostate
What are the facial/oral effects of tumour metabolites?
Facial flushing
Pigmentation
Amyloidosis
Oral erosions
How can you help relieve mucositis?
Benzadimine hypochlorise (Dyflan) - aqueous type better than alcohol as gives burning feeling
Frozen lidocaine lollipops or topical analgesics
Opiods
Avoid smoking, alcohol and spices
Good OH
Oral cooling with ice
How can you help manage patients whilst they are undergoing head and neck radiotherapy?
Discourage smoking and alcohol Saliva substitutes - olive oil around mucosa at night to prevent erosion Eliminate infections Relieve mucositis Physiotherapy for trismus
What are the oral complications of chemotherapy?
Infections Ulcers and mucositis Lip cracking Xerostomia and dehydration Delayed/abnormal development Gingival bleeding
How can you help manage patients after they have had head and neck radiotherapy?
OHI and prevention Fluoride Antibiotics for infections Specialists OMFS for XTNs Avoid mucosal trauma Saliva substitutes
How can you help manage patients whilst they are undergoing chemotherapy?
Systemic/topical folic acid to reduce ulcers
Ice cold water/sucking ice whilst on IV
CHX mouthwashes
Nystatin for candidiasis
Acyclovir for herpetic infection
Antibiotic for infections
Remember methotrexate interacts with NSAIDS/Aspirin
How can you help manage patients after they have had chemotherapy?
OHI and prevention
Risk of anaemia, bleeding and infection - pancytopenia all blood lines are decreased so must see recent FBC
What are the categories on the WHO mucositis scale?
1) soreness/erythema
2) erythema and ulcers but able to eat solids
3) ulcers/requires liquid diet
4) oral intake not possible
Who is responsible for coding oral cancer?
International Classification of disease (ICD) - latest = ICD-10
What is the trend for the incidence of oral cancer? What are the countries where 1/3 of their cancers are oral cancer?
What has been hypothesised for these trends?
Increasing incidence : increasing with age, increasing tongue cancer in young men, increase oro-pharyngeal cancer in males. M>F but gap narrowing
Sri Lanka and India
HPV, increase cannabis use
What patient factors determine survival after oral cancer?
Risk factors e.g. alcohol, tobacco Age Sex Presentation - early/late Socioeconomic status State of immune system Nutritional status
What tumour factors determine survival after oral cancer?
Site - e.g. will it metastasise quicker or require surgery
Size
Differentiation and biological behaviour of neoplasm - some more likely to proliferate
Immune response of host
Response to Tx - if found at early stage this is better
Existence and extent of metastases
What is the rate of malignant transformation for lichen planus?
Low
However little data on rates, lack of consistency in disease definition, diagnostic criteria, interventional treatment and follow up
What should you do if the relatives do not want you to tell the patient about some bad news?
Find out why
Explain it will be difficult to avoid telling and will more likely heighten patients worries and you will not lie to the pt under any circumstances.
Pt is of sound mind and is the only person to allow medical info about themselves to be disclosed
Where is the piriform fossa?
Either side of the larynx at the back
Why and when is hoarseness a symptom of laryngeal cancer?
Due to involvement of vocal cord
If persistent or worsening
If associated with pain (usually more advanced but can also indicate infective cause)
If associated with earache, dysphagia or stridor
If there is a lump in the oropharynx what may be the change to the voice?
Plumby sound as swollen
Why and when is sore throat and dysphagia a symptom of laryngeal and pharyngeal cancer?
If persistent
If localised or unilateral pain (tonsillitis is bilateral)
If associated with earache, stridor, foetor, bleeding (late sign), weight loss
If a patient C/O a feeling of lump in the throat, what signs indicate it is benign?
Stable/fluctuating Food/drink unaffected Anxiety associated Reflux To do with the failure of relaxation in the cricopharyngeal muscle (sphincter around the top of oesophagus)
If a patient C/O a feeling of lump in the throat, what signs indicate it is malignant?
Progressive (getting worse) Impairs solids and then liquids Weight loss Pain Neck mass Hoarseness
Why and when are ear symptoms a symptom of laryngeal and pharyngeal cancer?
Earache - referred pain from mouth tongue pharynx and larynx (glossopharyngeal nerve has branch from middle ear)
Deafness - very uncommon, middle ear effusion in adults due to nasopharyngeal tumour or child with glue ear
Why and when is difficulty breathing a symptom of laryngeal and pharyngeal cancer?
When cancer is advanced
Stridor - noisy breathing from upper airway obstruction - more difficulty breathing in
Why and when is pain a symptom of laryngeal and pharyngeal cancer?
Later feature in laryngeal
Due to ulceration may be early in pharyngeal
Which cancer in the throat doe not tend to spread?
Vocal cord cancer as poor lymphatic drainage
What is the main type of malignant cancer of the larynx and pharynx?
SCC
What is post-cricoid carcinoma (rare affecting mainly women) associated with?
Patterson Brown-Kelly (Plummer Vinson) Syndrome Sideropenic dysphagia (iron deficiency)
What are the treatment options for laryngeal and pharyngeal cancer?
Local excision if small e.g by laser Major resection +/- neck dissection Reconstructive surgery Radiotherapy +/- chemo Palliative care
What is TORS?
What cancers is it suitable for?
What are its advantages?
Trans-oral robotic surgery
Suitable for small oropharyngeal/base of tongue cancers
Has reduced need for chemo and reduced side effects
What is ablative surgery?
Removal of the cancer of the draining lymph nodes - significatn loss of ST
What is an obturator?
Why is it used?
Modified upper denture or reconstruction after major surgery
Pt doesn’t have to have secondary surgery good if elderly or comorbidities
What is the simplest healing technique after surgery?
Healing by secondary intention - heals without intervention - granulation tissue forms
When is primary closure used for oral cancer surgery?
Small intra-oral tumours
Posterior mandibular alveolus - lots of lax buccal tissues
What are the issues with primary closure for oral cancer surgery?
Must be tension free
Must avoid tethering
Risk of scar contracture
If soft palate closure is wrong then speech and swallowing problems
When is healing by secondary intention used for oral cancer surgery?
For dysplastic lesions e.g. lateral tongue border
In laser excisions
What is a skin graft (split)?
Watson knife (most superficial layer) and put graft from e.g. upper thigh in mesher to make holes so it can stretch over large area and heal without scarring
What are the intraoral tissues used in the mobilisation of local tissues technique for oral cancer surgery?
Buccal fat pad
Tongue flap
Pharyngeal wall
What are the cutaneous tissues used in the mobilisation of local tissues technique for oral cancer surgery?
Nasolabial flap - pedicle flap relying on nasolabial artery
Complex skin flap - large defect, rotated skin but better than having tissue removed from somewhere else
What are the tissues that can be used in the myocutaneous pedicled flap technique for oral cancer surgery?
Trapezius
Latissimus dorsi
Pectoralis major
(but nor as good functionality)
When are microvascular tissue transfers (free flaps) used for oral cancer surgery?
When there is significant functional or aesthetic loss
When local/regional tissue is unavailable or inadequate
When the pt is fit (long operation under anaesthesia)
What types of free flaps are used for oral cancer surgery?
Radial forearm (uses radial artery which is then attached to external carotid, can also use part of radius bone)
Antero-lateral thigh flaps - can get bigger areas of skin, more popular
Fibula - good if need bone as this is not particularly a functional bone
Iliac crest
Scapula
How is chemotherapy used as
a) Adjuvant Tx
b) Neo-adjuvant Tx
c) Induction chemo
a) Chemo given after surgery
b) Primary treatment for local control
c) Primary treatment in widespread disease - can shrink cancer to more manageable size for surgical treatment
What are the following in the cell cycle: G0, M, G1, G0, S, G2?
G0- stimulus M- Mitosis G1 - Protein and RNA synthesis G0 - Resting phase S - DNA synthesis G2 - RNA synthesis
What does it mean when chemotherapy’s kinetic classification is non-phase dependent? Give examples of drugs.
Kills cells exponentially with increasing dose. Eually toxic in cycle or G0.
5-fluorouracil
Alkylating agents
What does it mean when chemotherapy’s kinetic classification is phase dependent? Give examples of drugs
Kills cells at a lower dose but reach a plateau. Kill at higher doses because they are only effective in certain parts of the cell cycle
Methotrexate
Vinca alkaloids
What are the 4 main categories in the broad classification of chemotherapy?
Alkylating agents
Antimetabolites
Anti tumour antibiotics
Biological therapy e.g. IL2, alpha IFN
What are the acute toxicity complications that arise from chemotherapy treatment?
GI Toxicity - nausea and vomiting
Local toxicity -tissue destruction if injected out of vessel
Bone marrow toxicity - dose-limiting factor, pt can get pancytopenia where all cell lines destroyed so need regular FBC
Methotrexate - mucositis
Alopecia - 18-21 days after 1st injection, can be reduced by scalp cooling
What are the long term toxicity complications that arise from chemotherapy treatment?
Carcinogenesis - long term alkylating agents can lead to acute leukaemia
Gonadal damage - sterility
What does methotrexate do to the body that is the cause of ulceration?
Reduces folic acid content in body - ulcerations may respond to topical folinic acid
What drug from the dental formulary will increase the toxicity of methotrexate?
Aspirin
What drug has increased toxicity in patients taking methotrexate?
Suxamethonium (muscle relaxant)
If a patient has platelets >50x10^9/L, how should they be treated?
Routinely. Some may have desmopressin/platelet cover if surgery required
If a patient has platelets <50x10^9/L, how should they be treated?
Surgical procedures will cause bleeding. Platelets must be supplemented
If a patient has granulocytes >2x10^9/L how should they be treated? What about if <2x10^9?L?
> 2 - normal management
<2 - prophylactic antibiotics needed
What is the antibiotic cover for patients with indwelling cardiac catheters?
None - no longer required
a) Where is the thyroid gland located?
b) What is a generalised swelling of the thyroid gland called?
c) What would a localised, firm and fixed swelling in one of the lobes suggest?
a) Inf. aspect of anterior neck, butterfly shaped, 2 lobes joined by isthmus. Below thyroid cartilage and infront of trachea
b) Goitre
c) tumour
What could a lymph node enlargement suggest?
Lymphoma, leukaemia, metastatic tumour (e.g. from pharyngeal or skin cancer)
Inflammation or infection e.g. acute illness
What could be the differential diagnosis reasons for submandibular gland swelling?
Infective inflammatory or neoplastic
What is a plunging ranula?
A sublingual swelling due to defect in mylohyoid
What is actinomycosis?
Rare chronic infection/abscess caused by actinomyces. israeli from dental infection or trauma. Firm swelling unresponsive to treatment with multiple discharging sinus and sulphur particles in pus
What could a cervical lymphadenopathy be caused by if it has changed shape, is larger than 1 cm and has evidence of central necrosis?
Metastatic carcinoma - spread from a local sit to lymph nodes in neck
If a patient presents with a lump in their neck that is intermittent and develops at mealtimes, is tender to palpate but not fixed, what would you think it is? What would be a suitable investigation?
Salivary swelling
Ultrasound
If a patient presents with a small pimple in a larger swelling of the neck that is acutely painful, mobile and has discharging pus, what would you think it is?
Epidermal cerbatious cyst
Where would a parotid gland swelling present?
What would be the investigations?
Behind ramus of mandible, may cause deviation of earlobe
Examine facial nerve (may cause paralysis), ultrasound guided fine needle aspirate or core biopsy, CT scan
A neck swelling may have come from a dental infection. Where would the mandibular tooth lie if the swelling is in the
a) Submandibular space
b) Floor of mouth
a) below the mylohyoid muscle
b) above mylohyoid muscle
What are the cicular lymph nodes?
Submental, submandibular, pre and post auricular, parotid, retropharyngeal, occipital
What is the vertical chain of lymph nodes?
Superficial and deep chain (upper anterior, upper posterior, lower anterior, lower posterior)
What are the levels in the neck?
Level 1 = submandibular Level 2 = upper deep cervical Level 3 = mid cerval Level 4 = lower deep cervical Level 5 - posterior triangle Level 6 = anterior compartment
What are the most common reasons that a patient presents with generalised cervical lymphadenopathy
Inflammation or infection (loacalised or systemic) - from skin, dental, ear, throat or viral
If a patient has had chronic cervical lymphadenopathy persistent for >2/3 weeks, what could be the causes?
Viral - glandular fever, cytomegalovirus, HIV,
Bacterial - TB
What is the presentation of tuberculous cervical adenitis?
TB bacilli enter lymphatics causing nodes to be matted together. Non-painful necrosis produces ‘cold abscesses’ as no redness or heat. Chronic cough and systemic (fever)
Where would a thyroglossal duct cyst present?
Midline neck swelling along course of the thyroglossal duct (from base of tongue to thyroid gland - level 6). If pt protrudes tongue or swallows it will move upwards
Where would a dermoid cyst present?
Midline, higher up between bellies of genioglossus deep to mylohyoid. Presents as a submental swelling
a) What is cystic hygroma?
b) where and when does it present?
c) what is the management?
a) vascular malformation of lymph node origin which can be large and painful and comprimise the airway
b) 3/4 occur head and neck more commonly left and posterior of neck. Presents in childhood
c) Medically by injecting sclerosing agent or surgical
What is a branchial cleft cyst?
Proliferation of residual remnants of 2nd branchial cleft during development. They are bilateral lumps that can arise intermittently and can become infected
What is a sternomastoid tumour and how does it occur?
Thickening and shortening of SCM muscles present in neonates and children caused by trauma during birth. Head will be positioned towards affected side
If a patient has an extra rib originating from C7, how would this neck swelling present?
Firm swelling in supraclavicular region of neck
There is a swelling in the patients neck (usually presenting at middle age) that on palpation is a pulsatile mass, what could it be?
Carotid body tumour (arises at carotid bifurcation). Benign tumour - paraganglioma
What is a type 1 neurofibroma that could be a cause of a swelling in the neck?
Hyperpigmented skin, benign tumour along nerves
What is Troisier’s sign and where does it present?
Supraclavicular lymph node lump
Metastasis from abdominal malignancy e.g. stomach cancer or lung, oesophageal or breast cancer
What is a lipoma and how does it present?
A subcutaneous, non tender and non fixed
What do these types of cell growth mean?
a) Multiplicative
b) Auxetic
c) Accretionary
a) Increase in number of cells
b) Increase in size of cells via cytoplasm
c) Increase in extracellular matric e.g. bone growth
What are labile cells? Give examples
Cells continuously in cell cycle Haematopietic cells (e.g. bone marrow). Epithelial cells (skin, oral mucosa, GIT. Prone to hyperplasia and cancer)
What are stable cells? Give examples
Cells in reversible G0 with the ability to change
Hepatocytes (liver). Renal cells (kidney) - prone to hyperplasia, may regenerate as fibrous cells e.g. cirrhosis, less susceptible to cancer
What are permanent cells? Give examples
Cells in irreversible G0/non dividing
Cardiac muscle fibres (heart) - of MI then fibrosis/scar tissue and never heals. Neurons (brain). Can undergo hypertrophy but cancer of these cells rare)
What is hyperplasia? Give 3 examples of physiological hyperplasia and 2 examples of pathological
Increase in cell numbers by mitosis and/or decrease in apoptosis
- Wound healing
- Bone marrow e.g. increased erythrocytes at high altitudes
- Breast tissue in puberty and pregnancy
- Goitre (multinodular thyroid hyperplasia) in Graves Disease
- Gingival hyperplasia
What is hypertrophy? Give an example of physiological and pathological hypertrophy
Increase in cell size without division
- Masseteric hypertrophy
- Hypertrophic cardiomyopathy (increased size of myocytes)
What is atrophy? Give physiological and pathological examples
Decrease in size of a cell or organ
- Umbilical vessels, thymus, muscular if bed bound, everything in old age
- Atrophic alveolar ridge, oral lichen planus
What is metaplasia?
Reversible transformation of one mature differentiated cell type into another as an adaptive response to environmental stimuli.
Give 2 examples of metaplasia
Smoking - squamous metaplasia of trachea and bronchus to protect with keratin
Acid reflux - glandular metaplasia
What is dysplasia?
Loss of control leading to increase in cell growth, altered differentiation and overall change in architecture of tissue as a response to chronic injury. Is reversible in its early stages and has potential to turn into cancer
What is neoplasia and a neoplasm?
Neoplasia - new growth
Neoplasm = abnormal mass of tissue with uncoordinated growth. Characterised by genetic alterations that lead to loss of normal control mechanisms regulating growth and differentiation
What is a hamartoma?
Non-neoplastic overgrowth of tissue that is disordered in structure but composed of tissues indigenous to the site, grows with the individual (developmental)
What is a hamartoma-lymphangioma?
Abnormality derived form lymphatic channels that causes facial deformity, soft swellings in the mucosa and squashes lymph nodes
What are malignant epithelial neoplasms called? What are malignant mesenchymal neoplasms called?
Carcinomas
Sarcomas
What is a squamous cell papilloma?
Benign epithelial neoplasm causing a white lesion on lip - mainly driven by HPV
What is a basal cell adenoma?
Benign epithelial neoplasm in the parotid gland. Mobile on palpation, well circumscribed and no evidence of facial nerve palsy. Made of basaloid cells.
What is a lipoma?
Benign mesenchymal neoplasm that is well defined and yellowish made up of adipocytes and mature adipose tissue (fat)
What is an osteoma?
Benign mesenchymal neoplasm that is fixed well circumscribed in the cortical bone. Presents as a radiopacity
What is a pleomorphic adenoma?
Benign mixed neoplasm - most common salivary gland adenoma. If left untreated can turn into cancer: carcinoma ex PA
What is basal cell carcinoma?
Malignant epithelial neoplasm - ulcerated appearance with rolled margin, locally destructive but rarely metastasize
What is squamous cell carcinoma?
Most common oral cavity cancer commonly found on FOM and lateral tongue. Chronic non-healing ulcer, rolled margin, hard and stuck down to underlying tissues.
What is osteosarcoma?
Malignant mesenchymal neoplasm - uncommon. Osteoid = calcifications, hyperchromatic cells and malignant osteoblasts.
What does it indicate if lymph nodes are
a) soft and painful
b) soft and rubbery
c) hard and stuck
a) inflammatory lymph nodes
b) Lymphoma
c) malignant SCC
What is cachexia?
End stage - metabolic abnormality and sever muscle wastage
